Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Health Insurance

Gallup Reports 4-Year High in Number of Uninsured Americans

January 25, 2019 - Earlier this week, the Gallup National Health and Well-Being Index reported that the percentage of adults without health insurance reached 13.7 percent by the close of 2018. The polling group sampled more than 115,000 adults across the country. The latest increase continues an upward trend since the third-quarter of 2016 when the rate of uninsured Americans dipped to 10.9 percent, down...


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NYC Mayor Announces Plan to Guarantee Health Coverage for All Residents

by Jessica Kent

Mayor Bill de Blasio has announced the launch of a comprehensive, universal healthcare coverage plan that will guarantee benefits for every New Yorker. “Healthcare is a right, not a privilege reserved for those who can afford...

Nearly 50% of Pre-Medicare Adults Worried About Healthcare Costs

by Jessica Kent

Forty-five percent of adults aged 50 to 64 are not confident that they will be able to afford healthcare coverage in retirement, according to a poll conducted by the University of Michigan Institute for Healthcare Policy and Innovation and...

Employer-Sponsored Health Plans Prove Costly to Consumers

by Chuck Green

Workers and their families are spending a larger share of their income on their employer-sponsored health plans, according to a new study from the Commonwealth Fund. Coauthored by Sara Collins, Vice President of Health Care Coverage and...

Verma Shares Vision for More State “Flexibility” in Affordable Care Act

by Jessica Kent

CMS has released new policies that purport to help states create “alternatives” to the Affordable Care Act (ACA) and improve health insurance options, according to CMS Administrator Seema Verma. In an address to the States and...

AMA Study Finds Lack of Health Payer Competition Across US

by Kyle Murphy, PhD

Decreased competition in health insurance is likely to do more harm than good, new AMA study concludes. The America Medical Association released its most recent study of health payer competition, and the results fail to indicate the...

Health Payers Contend for Share of SMB Health Insurance Market

by Chuck Green

Changing government regulations and demands for benefits in the small to medium business market is likely to lead to consolidation and place a growing emphasis on creating innovative health plans, according to a recent Edifecs...

Rumors Swirl of Possible Walmart Acquisition of Humana

by Jennifer Bresnick

Walmart may be making a move to acquire Humana, one of the nation’s biggest health payers, according to The Wall Street Journal. Citing sources familiar with the matter – but without comment from Humana or Walmart – the...

CA to Investigate Aetna after Insurance Claim Review Admission

by Thomas Beaton

The California Insurance Commission has opened an investigation into Aetna’s medical practices after a former medical director for the company testified in court that he did not review patient records before approving or denying...

Health Insurance Costs Placing Stress on Majority of Americans

by Thomas Beaton

Sixty-nine percent of Americans with an income of $50,000 a year or more cited the cost of health insurance as a major stressor and 63 percent of Americans with incomes less than $50,000 per year cited insurance costs as a major life...

Optum to Purchase DaVita Medical Group for $4.9B

by Thomas Beaton

Optum, a subsidiary of UnitedHealth Group, has agreed to acquire DaVita Medical Group for $4.9 billion, expanding the health care services company’s footprint in the direct care delivery environment. The acquisition, expected to be...

CVS Health to Buy Aetna for $69B, Altering Payer Landscape

by Jennifer Bresnick

CVS Health is continuing its quest to become a major force in the growing world of consumer-centric healthcare by announcing that it will buy Aetna for $69 billion.  "This combination brings together the expertise of two great...

Senate Passes Tax Bill, Individual Mandate Repeal in 51-49 Vote

by Thomas Beaton

The US Senate voted 51-49 to reform national tax policy and simultaneously repeal the Affordable Care Act’s individual mandate, major news outlets reported at the end of last week. GOP senators only lost one Republican vote and were...

Ensuring High Out-of-Pocket Spending Won’t Lead to Negative Outcomes

by Thomas Beaton

High deductible health plans (HDHPs) are intended to reduce payer and beneficiary spending on healthcare services, but untenable out-of-pocket spending for beneficiaries could lead to patients letting preventable conditions develop into...

Integrated Medical, Pharmacy Benefits Help Costs, Member Engagement

by Jennifer Bresnick

Integrating medical benefits with pharmacy benefits can help healthcare payers and employer sponsors lower spending, improve member engagement, raise satisfaction, increase care coordination, and manage population health – ticking...

44% of Employees Don’t Know Value of Health Plan Benefits

by Thomas Beaton

Employers must increase their efforts to educate members about the value of their health plan benefits based on recent findings that only 44 percent of employees fully comprehend their benefits. That is the leading takeaway from research...

Bipartisan Senate Compromise May Reinstate CSRs, Alter 1332 Waivers

by Thomas Beaton

Senators Lamar Alexander (R-TX) and Patty Murray (D-WH)  have floated a bipartisan deal to reinstate the ACA’s cost-sharing reductions (CSRs) and boost individual enrollment outreach in exchange for alterations to the state 1332...

Health Plan Consumers Report Insufficient Payer Communications

by Thomas Beaton

Health plans may not be effectively communicating with consumers about member  benefits and largely fail to understand their members’ health and financial needs, a survey from Healthmine found. A sample of 750 consumers...

80% of Payers Investing in Member Engagement, Satisfaction

by Thomas Beaton

Eighty percent of health plans are focusing on improving member engagement and consumer satisfaction, according to a survey by Change Healthcare.   Member engagement is a growing opportunity for payers because of the potential...

Pediatric Data Reveals Private Payer, Medicaid Spending Gaps

by Thomas Beaton

Private payers spend close to twice as much on pediatric services as Medicaid, according to a statistical brief from AHRQ, highlighting significant disparities in cost related to visit type and geographical region. Data from the 2015...

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